• Medical Review Unit Director…

    Rising Medical Solutions (Chicago, IL)
    Rising Medical Solutions seeks a Medical Review Unit Director for our Workers Compensation based products and services. This role is ideal for a seasoned ... improving patient care and reducing healthcare costs through effective medical review processes. The Medical ...communication skills. + Proficient in the use of electronic medical record (EMR) systems and Microsoft Office… more
    Rising Medical Solutions (06/28/25)
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  • PS Medical Review Coordinator

    University of Utah (Salt Lake City, UT)
    …**Requisition Number** PRN42418B **Job Title** PS Program Assistant **Working Title** PS Medical Review Coordinator **Job Grade** C **FLSA Code** Nonexempt ... us and help give the gift of sight! The Medical Review Coordinator at the Utah Lions...for transplantation. This role involves completing donor charts, reviewing medical records , and applying knowledge of … more
    University of Utah (07/08/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Dover, DE)
    …skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and ... Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. +...close on: 08/07/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with… more
    CVS Health (08/01/25)
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  • Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    …to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing ... **Essential Duties & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review more
    Commonwealth Care Alliance (06/27/25)
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  • Medical Review Coordinator

    Prime Healthcare (Bristol, PA)
    …700 employees. Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/217672/ medical - review -coordinator/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)… more
    Prime Healthcare (07/25/25)
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  • Utilization Review Nurse (40 Hour)

    State of Connecticut, Department of Administrative Services (New Haven, CT)
    …monitor agency and third-party administrator files to oversee contractor handling; + May review medical records of various health care eligibility, resource ... medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims. MINIMUM QUALIFICATIONS - SUBSTITUTIONS… more
    State of Connecticut, Department of Administrative Services (07/23/25)
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  • Utilization Review Specialist RN - FT Days

    Houston Methodist (Sugar Land, TX)
    …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
    Houston Methodist (07/29/25)
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  • Utilization Review Services RN

    HCA Healthcare (Nashville, TN)
    …geographical market and productivity. **What you will do in this role:** + Conduct medical record review , validate admission status order, conduct a ... and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of...medical necessity review and provide clinical information to the payor +… more
    HCA Healthcare (08/03/25)
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  • Utilization Review Nurse - Transition…

    Houston Methodist (Houston, TX)
    …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
    Houston Methodist (07/25/25)
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  • Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family… more
    Children's Mercy Kansas City (06/17/25)
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